An assessment of the consistency of ASA physical status classification allocation

Abstract

SummaryThe American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by anaesthetists. A postal questionnaire was sent to 113 anaesthetists of varying experience working in the Northern Region of England. They were asked to allot ASA grades to 10 hypothetical patients. Ninety-seven (85.8%) responded to two mailings. In no case was there complete agreement on ASA grade, and in only one case were responses restricted to two of the Jive possible grades. In one case there was a signijicant diflerence in answers between anaesthetists with the FRCA (or equivalent) qualification, and those without. So much variation was observed between individual anaesthetist's assessments when describing common clinical problems that the ASA grade alone cannot be considered to satisfactorily describe the physical status of a patient.

Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

“…Although the anesthesiologist was not controlled in our study, because of its retrospective nature, the anesthesiologists who determined each patient's ASA score reported their findings at the time of surgery as part of normal clinical routine and not as part of our study. Studies of interrater consistency of the ASA score have observed its inconsistency [18,32] and imprecision [31,38]. As previously suggested [19], this poor interobserver reliability most likely is the result of difficulty in distinguishing a patient with normal health (ASA Class 1) from one with mild systemic disease (ASA Class 2) rather than discriminating between a relatively healthy patient (ASA Classes 1 and 2) and one with severe, even lifethreatening, systemic disease (ASA Classes 3 and 4).…”

Matching Clinicians to Operative Cases

“…After evaluation by an anesthesiologist patients are assigned a score between 1, which represents a normal healthy patient, and 5, which represents a moribound patient not expected to survive without the operation [1]. The ASA Physical Status Classification System is widely used but cases must be manually reviewed by an clinician, which is time consuming, subjective, and highly variable [12]. Attempts have been made to adapt existing tools such as the Therapeutic Intervention Scoring System-28 [8] or to develop new metrics with site-specific analyses based on direct observation [14].…”

Predicting outcomes: Is there utility in risk scores?

“…13 Notably, some prior research has found limited inter-rater reliability when anesthesiologists applied the ASA-PS scale to hypothetical case scenarios or de-identified medical records. [14][15][16][17][18][19] Conversely, more recent research has shown the scale to have at least moderate inter-rater reliability in usual clinical practice, with more than 98% of paired ASA-PS ratings of individual patients being within one class of each other. 20 Additionally, despite these potential limitations, the ASA-PS scale has shown at least moderate accuracy in predicting postoperative mortality across a wide range of studies.…”

“…The graph was plotted using the R Statistical Language Version 3.2.1 (Vienna, Austria) reliability. [14][15][16][17][18][19][20] Thus, whenever possible, a risk score and its individual components should have good inter-rater reliability.…”